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Background: Non-suicidal self-injury (NSSI) can be motivated by a broad range of functions and many individuals report multiple reasons for self-injuring. Most NSSI research has involved predominantly female samples and few studies have examined gender similarities and differences in function endorsement., Methods: We characterise the prevalence and versatility of NSSI functions within a gender-diverse online sample of cisgender women (cis-women; n = 280), cisgender men (cis-men; n = 176), and transgender, non-binary, and other gender non-conforming young adults (TGNC; n = 80) age 18-30 (M = 23.73, SD = 3.55). The Ottawa Self-Injury Inventory (OSI-F) assessed 24 intrapersonal and social functions across nine domains: affect regulation, self-punishment, anti-dissociation, anti-suicide, sensation seeking, sexuality, interpersonal influence, and body image., Results: TGNC participants and cis-women were significantly more likely to report intrapersonally motivated NSSI and greater function versatility than cis-men. Low mood, emotional distress, suicidality, and trauma symptomology appeared to contribute to gender differences in function endorsement. Gender similarities also emerged; across groups, intrapersonal functions were substantially more common than social functions, and the most endorsed domains were affect regulation and self-punishment. No domains were gender specific., Limitations: The OSI-F was developed from majority female samples and may not adequately capture the experiences of other gender groups., Conclusions: Interventions which reduce distress and strengthen emotion regulation are likely to benefit individuals who self-injure regardless of gender. However, most individuals report multiple NSSI functions and person-centred interventions which address this complexity are needed. Future research should develop gender-informed treatment models which consider the unique experiences of TGNC individuals and cis-men who self-injure., Competing Interests: Declaration of competing interest SRC receives honoraria from Elsevier for journal editorial work and his research was funded by Wellcome. TJF's research group receives funds from Place2Be for research consultancy; Place2Be is a third sector organization that provides mental health training and interventions to school staff and pupils. JEG has received research grant support from NIDA, Janssen and Biohaven Pharmaceuticals. JEG receives yearly compensation from Springer Publishing for acting as Editor-in-Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Inc., Norton Press, and McGraw Hill., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Non-suicidal self-injury (NSSI) is increasingly prevalent among patients with bipolar disorder (BD), raising concerns in psychology and mental health. Investigating the incidence and factors associated with NSSI is crucial for developing prevention and intervention strategies., Methods: NSSI behaviors were identified using the Ottawa Self-injury Inventory. The Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 specifier of mixed features (CUDOS-M) and the Mini International Neuropsychiatric Interview (Hypo-)Manic Episode with Mixed Features-DSM-5 Module (MINI-M) were used to evaluate clinical symptoms. Non-parametric tests, chi-square tests, point-biserial correlation and logistic regression analyses were employed for the purposes of data analysis., Results: The enrolled sample comprised 1044 patients with BD from 20 research centers across China. Out of 1044 individuals, 446 exhibited NSSI behaviors, with 101 of them being adolescents, leading to a prevalence of 78.3 % among adolescent patients. The most common methods for females and males were "cutting" (41.2 %) and "hitting" (34.7 %), respectively. By binary logistic regression analysis, young age, female, bipolar type II disorder, with suicidal ideation and mixed states, depressive symptoms and without family history of mental disorder were correlates of NSSI in patients with BD (P < 0.05)., Limitations: As a cross-sectional study, causality between NSSI behaviors and associated factors cannot be established. Reporting and recall biases may occur due to self-rating scales and retrospective reports., Conclusion: Our study indicates a concerning prevalence of NSSI, particularly among young patients with BD in China. Future research should focus on understanding NSSI behaviors in this population and developing effective interventions., Competing Interests: Declaration of competing interest We have no conflicts of interest concerning this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Nonsuicidal self-injury (NSSI) is prevalent among emerging adults in post-secondary school, but little is known about change and stability in NSSI during the transition to university. Moreover, there has been limited person-centered work focusing on heterogeneity in NSSI engagement among students over time. The present study aimed to investigate the development and maintenance of NSSI across the first year of university and explore predictors of potential variability in trajectories of NSSI., Methods: The present sample consisted of 1125 first-year university students at a large post-secondary institution (Mage = 17.96, 71 % female, 28 % male, 1 % gender diverse) who participated in a larger longitudinal study. Participants completed an online survey three times over their first year of university. Latent growth curve modeling (LGCM) in Mplus was utilized to explore different NSSI group trajectories across first year university., Results: NSSI was prevalent among first year students (35 %). LGCM revealed one developmental trajectory; NSSI engagement decreased across the first year of university. Students who engaged in NSSI had increased difficulties with emotion regulation, lower self-compassion, and lower levels of social support compared to students who did not engage in NSSI., Limitations: The present study may be subject to recall errors and future studies should include more gender diverse samples to increase generalization of findings., Conclusions: Findings highlight the transition to university as a peak period of vulnerability for NSSI engagement and emphasize the need for proactive university intervention efforts to mitigate risk and improve student well-being., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Non-suicidal self-injury (NSSI) is a significant public health concern. Research and treatment interventions largely focus on stopping self-injury. People who self-injure do not necessarily equate recovery to cessation. Qualitative accounts allow greater understanding of personal recovery narratives. This study aimed to synthesise personal conceptualisations of NSSI recovery., Methods: Participants had lived experience of NSSI and discussed their recovery. Papers not written in English or had a quantitative design were excluded. Four databases (PsycInfo, CINAHL, Medline and Web of Science) were systematically searched. The quality of each paper was assessed using the CASP quality assessment tool. Data were synthesised using a meta-ethnographic approach., Results: Thirteen studies comprising 159 participants were included. Three overarching themes were developed. While ceasing NSSI was an important aspect of recovery for some, recovery was typically viewed more holistically, encompassing developments within the self and relationships. Recovery was regarded an ongoing non-linear journey. The personal and multifaceted nature of the recovery process emerged through a line of argument synthesis., Conclusions: This was the first qualitative synthesis of personal conceptualisations of NSSI recovery. The findings highlighted the personal and multifaceted nature of NSSI recovery and supported person-centred models of self-injury recovery. Clinical implications include the importance of expanding self-injury recovery beyond cessation within research and clinical practice, and for collaborative and person-centred approaches to be embraced when supporting those who self-injure., (© 2024 The Author(s). Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)

Non-suicidal self-injury (NSSI) is an emerging concern in the field of public health. The objective of this study is to develop a conditional process model to investigate the relationship between social anxiety and NSSI, and the role of impulsiveness and self-esteem in this relationship. A convenience sample of 2717 university students (M age  = 19.81, 22.49% male) from Southern China was recruited. The age range of the participants is between 18 and 25 years. The data were analysed using Spearman correlation analysis, mediation analysis and moderation analysis. The study revealed a positive correlation between social anxiety and NSSI, with impulsiveness serving as a mediating factor in this association. The relationship between social anxiety and NSSI, impulsiveness and social anxiety, impulsiveness and NSSI were all found to be moderated by self-esteem. The prevalence of NSSI among college students exhibited a strong association with social anxiety and impulsiveness. The present investigation additionally demonstrated that there was no significant association between social anxiety, impulsivity and NSSI when high self-esteem was included. This finding implies that self-esteem plays a crucial role in safeguarding against NSSI., (© 2024 International Union of Psychological Science.)

This study aimed to identify protective and risk factors related to non-suicidal self-injury (NSSI) behaviour among young adults in their 20s in Korea, providing an integrated perspective based on the Problem Behaviour Theory (PBT). The subjects were 650 young people in their 20s recruited through the promotion of mental health welfare centres in Seoul, Gyeonggi-do and Jeju-si in Korea. A self-report scale was used to measure NSSI and resilience, social support, self-compassion, childhood adversity, depression, anxiety and anger. The collected data were analysed using the SPSS 27.0 program, and hierarchical logistic regression analysis was performed to identify the protective and risk factors related to NSSI behaviour. As a result of this study, out of 650 participants, 107 (16.46%) were found to have experienced NSSI. The NSSI group was younger and had a higher proportion of females compared with the non-NSSI group. In addition, self-compassion was identified as a protective factor and childhood adversity and depression were identified as risk factors associated with NSSI behaviour. The lower the self-compassion, the higher the childhood adversity and the higher the depression, the higher the likelihood of NSSI behaviour. Based on the results, mental health services should be provided to young people with childhood adversity and high levels of depression, and efforts should be made to respond appropriately to self-injury crises. In addition, it is considered necessary to develop a program to increase the level of self-compassion to protect against the NSSI behaviour of young people in their 20s in Korea., (© 2024 John Wiley & Sons Australia, Ltd.)

Objective: The current study evaluated frequency of nonsuicidal self-injury (NSSI) and associated maladaptive traits between three time periods: pre-pandemic, early pandemic, and later pandemic. Participants: Two college student samples (n = 362; n = 337) were collected via two online studies. Method: Participants completed measures assessing maladaptive borderline personality traits, engagement in NSSI over the past month, and reasons for and types of NSSI engaged in across the lifetime. Results: Results demonstrated a stable and potentially a slight increase in general rates of NSSI over the course of the pandemic. Further, specific maladaptive traits that underly borderline personality disorder (i.e., despondence, fragility, self-disturbance, and anxious-uncertainty) were related to engagement in NSSI 1-month post COVID. Conclusion: The study highlights the need for added interventions that might reach at risk populations during these heightened periods of stress.

Purpose: Brief Admission by self-referral (BA) is a standardized crisis-management intervention for individuals with self-harm and risk for suicide. This study explored relatives' experiences of BA. Relatives' perspectives may contribute to an increased understanding of the effects of BA given the relatives' role as support and informal caregivers as well as being co-sufferers., Methods: Fourteen relatives to adults with access to BA within one Swedish region participated in focus groups analysed with reflexive thematic analysis., Results: We generated themes evolving around three meaning-based concepts: access (A low threshold to a safe back-up is crucial and obstacles may easily break faith), independence (Trust in their ability with care and respect), and recovery (The rest and relational recovery we all get are needed and invaluable)., Conclusions: BA brings considerable value to users and relatives, by supporting them to take care of themselves and each other. Communication and involvement of relatives may enhance users' ability to overcome obstacles to accessing BA. Implementation and adherence may be strengthened by supervision of BA staff and education of emergency care staff. Resources are needed to improve access. Mapping hurdles to BA, support through peers and targeted psychoeducation may improve recovery for BA users and their relatives.

Purpose: Teenage pregnancy remains a significant global public health concern worldwide. However, it presents a complex phenomenon in developed countries, carrying potential short- and long-term consequences for both mothers and children., Methods: This mixed method study used data from the French cross-sectional study "Portraits of adolescents", which included 6000 girls aged between 13 and 17 years. The quantitative approach involved comparisons between a subgroup with an history of pregnancy and their peers, examining their lived-experience and mental health. The qualitative approach investigated the question "What does being a teenager mean for you?" specifically for the girls who reported an history of pregnancy., Results: Teenage pregnancies presented elevated rates of mental health disorders, including dark thoughts, depression, self-harm, participating in dangerous games, attempting suicide and increased use of psychoactive substances. With limited support, in comparison to their peers. The qualitative approach revealed three major themes: "being in action", "a way of feeling", and "quality of relationship"., Conclusion: This vulnerable subgroup of adolescents suggests the need for a coordinated multidisciplinary healthcare approach, given their limited parental and friend support, with a high risk of experiencing poor mental health. Additionally, these findings portray a "silent sufferer" population characterized by difficulties recognizing or managing emotions due to difficulties in expressing their emotional distress.

Background: Individuals reporting self-injury are at greater risk of several adverse outcomes, including suicide. There is reason to be concerned how these individuals cope when stressful life events increase. This study aimed to investigate the trajectories of anxiety and depressive symptoms and the predictive value of self-injury history in individuals with psychiatric symptoms during the unique and stressful conditions of the COVID-19 pandemic., Methods: In a longitudinal population cohort study (N = 1810) ranging from 2020 to 2022, anxiety (measured by Generalized Anxiety Disorder, GAD-7) and depressive symptoms (measured by Patient Health Questionnaire, PHQ-9) were self-reported monthly during 12 months. Latent growth curve models with and without self-reported self-injury history as predictors were conducted., Results: Overall, anxiety and depressive symptoms decreased from baseline, but remained at moderate severity at follow-up. Individuals reporting suicidal or nonsuicidal self-injury reported significantly higher symptom severity at baseline. In addition, individuals reporting suicidal self-injury demonstrated a slower rate of decline in the symptom load over the course of 12 months., Conclusions: Over the course of 12 months, anxiety and depressive symptoms decreased in individuals with psychiatric symptoms, but still indicate a psychiatric burden. Individuals with a history of self-injury could be more vulnerable in face of stressful conditions such as those experienced during the COVID-19 pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ojala et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The literature on the trajectories of NSSI behavior during the pandemic is scarce and mainly short-term. Furthermore, studies have not explored the buffering mechanisms that may have altered risk trajectories during this vulnerable period. This study aims to analyze the univariate change of NSSI during adolescence and to examine the alteration of the univariate growth due to the time-varying effect of COVID-19-related stress, parenting dimensions (i.e., positive and negative parenting), and their interaction., Methods: Participants included 830 Italian adolescents (44.2 % females; M age  = 14.52; SD = 0.80), who participated in at least one time point of data collection, from a three-wave longitudinal study (T1: from December 2019 to January 2020; T2: December 2020; T3: December 2021)., Results: The Latent Growth Curve Analyses show a linear increase in NSSI over time. In regards to time-varying, at T1, the results highlight that higher levels of negative parenting are associated with higher levels of NSSI at the same time point. Instead, at T2, results show that pandemic stress is associated with higher levels of NSSI at T2. Regarding the interaction effect, positive parenting significantly buffered the effect of COVID-19 stress on NSSI at both T2 and T3., Limitations: Only some dimensions of parenting style (i.e., positive and negative parenting) are included., Conclusions: This study attempts to deepen the trajectory of NSSI behavior during the two years of the pandemic and examine the changes caused by the time-varying effects, thus providing suggestions for designing programs to prevent engagement in NSSI., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Complex ethical considerations can arise when patients with severe, persistent mental illness (SPMI) present with critical illness resulting from self-injury. This article presents 2 clinical cases in which a patient with SPMI was admitted with severe injuries following self-inflicted burns, with a substantial impact on their anticipated quality of life and challenges directing their medical care. In both cases, the medical teams held discussions with surrogate decision-makers in order to evaluate the patient's minimal acceptable quality of life and make medical decisions that best reflected the patient's voice and goals. These cases underscore the importance of advance care planning in SPMI, particularly the appointment of a surrogate decision-maker, and highlight the moral distress that can arise among surgical teams and trainees while caring for patients with illness resulting from self-harm. This article offers a framework for approaching decision-making in critical illness resulting from self-harm for patients with SPMI., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: During the COVID-19 pandemic, the global incidence of non-suicidal self-injury (NSSI) has been increasing year by year, especially among adolescents, and it is highly correlated with the level of anxiety among teenagers, particularly within Chinese cultural contexts where parenting styles significantly influence adolescent behavior., Objective: This study examines the role of culturally-influenced parenting styles and adolescent coping strategies in relation to anxiety and NSSI behavior, aiming to clarify these multivariate interactions for better understanding and intervention., Methods: A cross-sectional survey was conducted with NSSI-diagnosed adolescents from Affiliated Kangning Hospital, Ningbo, China, and healthy adolescents from urban schools. Data on background, parenting styles, coping strategies, and anxiety levels were analyzed using chi-square tests, independent sample t -tests, MANOVA, and regression analysis., Results: Adolescents with NSSI reported higher anxiety levels, more punishment and interference, and less emotional warmth from their fathers compared to the non-NSSI group ( p  < 0.001). The NSSI group also relied more on emotion-oriented coping strategies, while the non-NSSI group favored problem-oriented approaches ( p  < 0.001). Multivariate analyses confirmed significant effects of NSSI behavior, parenting styles, and coping strategies on anxiety levels., Conclusion: This study found that the anxiety levels of NSSI adolescents were significantly higher than those of non-NSSI adolescents in China, which was closely related to less emotional warmth from parents, more punishment and interference, and emotion-focused coping strategies. The results demonstrate that family environment and coping strategies play a critical role in NSSI behavior and anxiety levels, highlighting the importance of emphasizing emotional support and positive coping strategies in the prevention and intervention of NSSI behavior., Competing Interests: The authors declare there are no competing interests., (©2024 Liu et al.)

Objective: This study aims to examine the relationship and mechanism between sense of self and nonsuicidal self-injury among college students, providing a new theoretical basis for predicting and preventing such behavior., Methods: A total of 1350 college students completed the Sense of Self scale, nonsuicidal self-injury questionnaire, frustration scale, and social problem-solving questionnaire., Results: (1) Negative Sense of Self predicts frustration, and frustration positively predicts nonsuicidal self-injury. (2) Frustration serves as a partial mediator in the relationship between sense of self and nonsuicidal self-injury. (3) The impulsive-negligent social problem-solving style regulates the first half of the mediation model by influencing the relationship between sense of self and frustration., Conclusion: Frustration, mediated by sense of self, increases the risk of nonsuicidal self-injury, and this relationship is moderated by the impulsive-negligent social problem-solving style. Sense of Self is a necessary but not sufficient condition for nonsuicidal self-injury, indirectly influencing such behavior through frustration triggered by stress events., Competing Interests: Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Jiangxi Education Department (protocol code 21YB008 and 2021/01 of approval). Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Teenage suicide-related behaviors have been highlighted in Japan in recent years, but the background factors and characteristics of these behaviors have not been clarified. Therefore, we investigated the characteristics of teenage suicide attempters who were admitted to an emergency room., Methods: The subjects were suicide attempters in their teens and twenties who were admitted to the Critical Care Medical Center of Nippon Medical School Hospital between January 1, 2010 and December 31, 2021. The means of suicide attempt, sociodemographic data, psychiatric diagnoses, and causes and motives for suicide attempts were retrospectively examined from medical records. Teenage suicide attempters were compared to those in their twenties in regard to the acquired data, and logistic regression analysis was conducted to evaluate the influence on teenage suicide attempts by the aspects that have been shown to be closely associated with teenage suicides., Results: Among 860 suicide attempters between 2010 and 2021, 59 (6.9%) were teenage suicide attempters and 216 (25.1%) were suicide attempters in their twenties. The large number of females, the history of self-harm, the great number of drug overdoses as a means of attempting suicide, and the large number of individuals with psychiatric disorders, especially with mood disorders and personality disorders, were commonly shared by suicide attempters both in their teens and twenties. On the other hand, family problems, school problems and autism spectrum disorder significantly influenced mostly teenage suicide attempters., Conclusions: It was suggested that teenage suicide attempters may have attempted suicide due to environmental difficulties and conflicts about not being able to escape from them. It has become clear that teenage suicide attempters have unique characteristics and background factors, and that it is important to take these into account when taking measures to prevent teenage suicides., (© 2024. The Author(s).)

Background: Self-harm is a major health issue resulting in high societal costs. Few psychological and psychosocial interventions have shown effectiveness in reducing repeat self-harm., Objective: To assess the cost-effectiveness of psychological and psychosocial interventions that have shown evidence of effectiveness in adults and CYP (children and young people) who have self-harmed., Methods: Using effectiveness data from Cochrane reviews, we developed two decision-analytical models to compare costs and quality-adjusted life years (QALYs) of cognitive behavioural therapy (CBT)-informed psychological therapy added to treatment as usual (TAU) versus TAU alone for adults who have self-harmed, and of dialectical behavioural therapy for adolescents (DBT-A) versus enhanced TAU for CYP who have self-harmed, respectively, from a National Health Service and personal social services perspective in England. Other model input parameters were obtained from published sources, supplemented by expert opinion., Findings: The incremental cost-effectiveness ratio (ICER) of CBT-informed psychological therapy added to TAU versus TAU alone for adults who have self-harmed was £9088/QALY. The ICER of DBT-A versus enhanced TAU for CYP who have self-harmed was £268 601/QALY. Results were overall robust to the alternative scenarios tested., Conclusions and Clinical Implications: CBT-informed psychological therapy appears to be cost-effective for adults who have self-harmed, which contributes to evidence for its implementation in services. Currently, DBT-A does not seem to be cost-effective for CYP who have self-harmed. The economic analyses were informed by clinical evidence of moderate-to-low (CBT) and low (DBT-A) quality. Further clinical and economic evidence for DBT-A and other psychological and psychosocial interventions for people who have self-harmed is required., Competing Interests: Competing interests: IM, FP, RC and SP received support from the National Institute for Health and Care Excellence (NICE) for the submitted work. AW, AC, FM, KL and NK declared the following interests based on NICE’s policy on conflicts of interests:https://www.nice.org.uk/guidance/ng225/documents/register-of-interests. KH is a member of the National Suicide Prevention Strategy for England Advisory Group. The authors report no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.)

Importance: A decline in nonsuicidal self-injury (NSSI) behavior is often viewed as an indication of mental health improvement when treating adolescents and young adults with borderline personality pathology. However, evidence shows that an initial decrease in NSSI behavior does not always signal recovery, and potential symptom shifting needs to be considered., Objective: To examine the codevelopment of NSSI and substance use in adolescents and young adults receiving treatment for NSSI behavior and to explore whether shifting from NSSI behavior to substance use is associated with emerging or persistent borderline personality pathology., Design, Setting, and Participants: This cohort study used data from the AtR!Sk study. The study included a consecutive sample of adolescents and young adults with NSSI behavior who presented to a specialized outpatient clinic for early intervention of borderline personality pathology. A baseline assessment (between May 3, 2016, and December 19, 2019) and 2 annual follow-up assessments were conducted. Data were analyzed from April 15, 2023, to September 5, 2024., Main Outcomes and Measures: The frequencies of NSSI behavior and substance use were self-reported. Diagnostic interviews were carried out to assess borderline personality pathology. Growth mixture models were specified to identify latent classes with different joint trajectories of NSSI behavior and substance use, and the classes were compared for the number of fulfilled borderline personality disorder (BPD) diagnostic criteria., Results: Overall, 277 adolescents and young adults (249 [89.9%] female; mean [SD] age at baseline, 14.9 [1.5] years) were included in the study (number at first follow-up, 135; number at second follow-up, 82). Three latent classes were extracted from the data. A decline in NSSI behavior following treatment was common. Class 1 (estimated class count: 32.5; 11.7% of participants) was further characterized by a decline in substance use; class 2 (210.1; 75.9% of participants), by a moderate increase in substance use; and class 3 (34.4; 12.4% of participants), by a strong increase in substance use. The number of fulfilled BPD diagnostic criteria in class 1 (mean [SE], 4.64 [0.40]; comparison: χ2, 11.64; P < .001) and class 3 (mean [SE], 4.29 [0.41]; comparison: χ2, 5.98; P = .01) was greater than that in class 2 (mean [SE], 3.18 [0.15]) at baseline. The number of fulfilled BPD criteria remained high at the second follow-up assessment in class 3 (mean [SE], 5.15 [0.84]) but not in class 1 (mean [SE], 2.05 [0.54])., Conclusions and Relevance: In this cohort study of adolescent patients with NSSI behavior, a decline in this behavior was commonly paired with an increase in substance use. This finding suggests that a decrease in NSSI behavior alone may be insufficient to indicate treatment success. Monitoring the joint trajectories of NSSI behavior and substance use may be a promising avenue toward early detection and targeted treatment of adolescent borderline personality pathology.

Suicidal behavior and non-suicidal self-harm in vulnerable groups and population minorities pose a challenge for suicidology, complicating the universality of suicide. The goal of this paper is to analyze the lives of young women from marginalized communities, considering their experiences with suicidality and their relational and violent horizons. Nine women who took part in the fifth wave of a cohort on mental health and violence (2005-2022) in São Gonçalo, Rio de Janeiro State, Brazil, were interviewed (2022) about the contexts that kept them from committing suicide despite significant emotional distress from childhood through youth. From theme-based content analysis, three categories stood out and may contribute to an intersectional, decolonial and socially relevant approach to preventing self-destructive behavior. In the first, views on self-inflicted violence, better explained by the cores concepts of "sin" and "illness" than by the general violence they experienced. In the second, indirect references to self-harm behavior, where it was recognized that the use of euphemisms reflects not only the taboo but also the silencing of and discrimination against minorities. In the third, layers of protection and turning points, where "spirituality", "occupation" and "motherhood" were interpreted as the main associations between factors of protection and resilience in the trajectories and daily lives of these young women. A closer look that acknowledges the humanity, rights and psychological distress of groups subjected to violence and discrimination not only enhances care and prevention of suicidal behavior but also deepens understanding of this human and universal phenomenon.

Background: Suicidal ideation may be a warning sign for suicide and previous work has indicated a higher prevalence of suicidal ideation during the COVID-19 pandemic. Job loss and job insecurity are potential risk factors for suicidal ideation, but their importance during the pandemic, and the role of organizational changes for suicidal ideation, is unclear. This study examined the association between various experiences associated with job loss and job insecurity during the pandemic and thoughts of suicide/self-harm in Sweden., Methods: The study sample was drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH). Auxiliary data collections in February 2021 and 2022 assessed exposure to job loss/unemployment, furlough, workplace downsizing, or increased job insecurity versus stable employment and thoughts of suicide or self-harm (PHQ-9) during the pandemic. The analyses were based on 1558 individuals (2 349 observations) participating in either or both waves and who had been working before the pandemic. Logistic regression models with cluster-robust standard errors were fitted, including sociodemographic factors and prior mental health problems to control for potential confounding. Measures of personality based on a brief version of the Big-Five personality inventory were also added., Results: The results indicated an association between all experiences, except furlough, and thoughts of suicide/self-harm, when adjusting for sex, age, civil status, socioeconomic status and prior mental health (job loss odds ratio (OR) = 3.70, 95% confidence interval (CI) 1.79-7.63, downsizing OR = 2.41, CI 1.24-4.70, job insecurity OR = 2.77, CI 1.15-6.67). The associations for job loss and insecurity were attenuated by adjustment for personality, although it remained statistically significant for downsizing., Conclusions: The results suggested a higher risk of suicidal ideation connected with loss of employment and survival of a downsizing, but not a forced reduction in working times/pay during the COVID-19 pandemic. The association for subjective job insecurity was less robust and may be partly explained by personality., (© 2024. The Author(s).)

Dialectical Behaviour Therapy (DBT) has demonstrated effectiveness in reducing harmful behaviours associated with emotion dysregulation, including non-suicidal self-injury (NSSI) and binge eating. It has been hypothesized that the effects of DBT on NSSI and binge eating are the result of improvements in emotion regulation (ER); however, the extent to which changes in ER account for reductions in these behaviours is unclear. The present study leverages two unique clinical samples to examine the degree to which changes in ER influence changes in the frequency of NSSI and binge eating over the course of DBT. Participants included 189 Veterans receiving outpatient DBT and 117 civilians enrolled in a DBT Intensive Outpatient Program. Analyses examined changes in ER, binge eating and NSSI over the course of treatment, as well as the extent to which NSSI and binge eating frequency were influenced by changes in ER. In the Veteran sample, DBT led to improvements in ER abilities and significant reductions in NSSI and binge eating; however, changes in ER did not account for observed reductions in NSSI or binge eating. In the civilian sample, the effects of DBT on ER, NSSI and binge eating were nonsignificant. Our findings suggest that ER may not be the only mechanism through which DBT exerts its effects on NSSI and binge eating. The effects of DBT on ER and self-damaging behaviours may vary based on factors such as treatment setting, time in treatment and clinical severity of the sample., (© 2024 John Wiley & Sons Ltd.)

Cyber aggression is prevalent among emerging adults and is associated with a range of mental and behavioral issues. One particularly concerning outcome is the widespread presence of suicidal ideation in this group, which poses a significant threat to their life. However, the specific impact of cyber aggression on suicidal ideation and the longitudinal mechanisms remains unclear. Hence, this study sought to address these gaps by applying the general aggression model (GAM). The investigation utilized three-wave longitudinal data with 6-month intervals from a large sample of Chinese emerging adults (N = 1568; 54.7% female; M age  = 19.70 [SD = 1.44], ranging from 17 to 26 years). The random-intercept cross-lagged panel model (RI-CLPM) was employed to explore the roles of depressive symptoms and nonsuicidal self-injury (NSSI) between cyber aggression and suicidal ideation at both the between- and within-person levels. The findings indicated that, at the between-person level, there were trait-like associations between depressive symptoms and cyber aggression, NSSI, and suicidal ideation. At the within-person level, cyber aggression exhibited unidirectional positive cross-lagged effects on depressive symptoms and NSSI, and could subsequently indirectly lead to suicidal ideation via the contemporaneous associations from depressive symptoms and NSSI to suicidal ideation. These results not only align with GAM but also shed light on the underlying mechanisms linking cyber aggression to suicidal ideation. Also, the findings underscore the significance of maintaining a positive network environment for the well-being of all internet users even cyber aggression perpetrators., (© 2024 Wiley Periodicals LLC.)

Introduction: Recent research shows that there has been a decrease in meaning in life and an increase in hopelessness and nonsuicidal self-injury in adolescents after the pandemic. The present study aims to address three objectives: (1) to compare the frequency, types and functions of nonsuicidal self-injury before and after the pandemic, (2) to explore the relationship between meaning in life, hopelessness and nonsuicidal self-injury and (3) to study differences in nonsuicidal self-injury, meaning in life and hopelessness levels before and following the pandemic., Methods: This research was conducted in a community sample of N = 3800 Spanish participants, including n = 1733 from the pre-pandemic period and n = 2067 from the post-pandemic period. Ages ranged between 11 and 19, and the average age was 14.87 (SD = 1.58). The sample had an equal distribution by gender, with 50.5% females (n = 1919) and 49.5% males (n = 1881). Standardized tests such as ISAS-II, BHS and PIL-10 were used, as well as descriptive statistics, Spearman correlations and non-parametric ANCOVAs of Quade controlling for age and gender to compare pre- and post-pandemic variables., Results: The results revealed a significant increase in the number of functions of nonsuicidal self-injury, in the methods employed and in the levels of hopelessness, along with a notable decrease in meaning in life after the pandemic. However, the estimated prevalence of pre- and post-pandemic nonsuicidal self-injury remained similar. The estimated lifetime prevalence of NSSI was 24.9% (n = 432) before the pandemic and 19.4% (n = 401) after the pandemic. A positive correlation between nonsuicidal self-injury and hopelessness and a negative correlation with meaning in life were observed., Conclusions: These findings indicate that the pandemic influenced the mental health of young Spaniards and suggest it may be useful to incorporate meaning-centred interventions in protocols to address nonsuicidal self-injury and hopelessness in adolescent populations., (© 2024 The Author(s). Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Background: As nonsuicidal self-injury (NSSI) has become an increasing public health concern, the last few years have seen the emergence of efforts to address NSSI recovery. Although many recovery efforts adopt a medical view of self-injury and focus on cessation of the behaviour, recovery can mean many different things to different people. In this study, we provide initial empirical validation of the self-injury recovery framework, by assessing whether different recovery profiles exist., Methods: Our sample comprised 733 participants with lived experience of NSSI (M age = 24.54, sd = 6.39). Participants completed self-report measures of constructs related to NSSI recovery and NSSI characteristics., Results: Using latent profile analysis, we identified six unique profiles reflecting differences in thoughts/urges to self-injure, self-efficacy, social support, optimism, coping, underlying adversities, perceptions of scarring, disclosure, resilience and self-compassion. Multivariate analyses of variance confirmed these profiles differed according to NSSI characteristics such as frequency of NSSI, a self-assessment of recovery, the desire to self-injure or avoid self-injury and the number of people disclosed to., Limitations: A homogenous sample and cross-sectional design limit generalisability of our findings across populations and across time., Conclusions: Our findings reinforce that recovery can take many different forms, with different factors being relevant to different individuals. Adopting a person-centred approach that centres an individual's lived experience and emphasises what is important to them in the recovery process offers opportunities for more empathic responses to self-injury and better outcomes for individuals who self-injure., (© 2024 John Wiley & Sons Ltd.)

Background: Non-suicidal self-injury (NSSI) is highly prevalent among adolescents. However, knowledge about the possible factors that might precede and influence its development remains scarce., Objective: Our goal is to examine the impact of adverse childhood events, and more specifically of different types of childhood maltreatment (CM) in adolescent NSSI. This involves performing a systematic review and meta-analysis of the different CM subtypes (physical and emotional neglect, physical and emotional abuse, sexual abuse) in clinical and non-clinical samples of adolescents with NSSI., Participants and Methods: A digital search of the PsycInfo, PubMed and Web of Science platforms for articles published up to June 2022 was performed. The search terms were "self harm", "non-suicidal self-injury", "childhood maltreatment" and "adolescents"., Results: Forty-six articles that fit the research objectives were included in the study, which covered a total of 1,505,430 adolescents, of whom 560,337 belonged to the NSSI group, while 945,093 were in the control group. The results describe strong positive associations between all CM subtypes and NSSI, especially with emotional abuse (odds ratio [OR] 2.91, 95 % CI 2.37-3.56) and sexual abuse (OR 2.72, 95 % CI 2.12-3.48), in clinical and non-clinical samples of adolescents., Conclusions: The experience of CM, and especially emotional and/or sexual abuse, seems to be associated with a greater risk of developing NSSI in adolescence. Therefore, early identification and detection of children who have suffered or are suffering these forms of CM are of vital importance for instigating psychotherapeutic treatments that can minimize the risk of developing NSSI in adolescence., Competing Interests: Declaration of competing interest The autors have no competing interests to declare that are relevant to the content of this article., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The use of positive coping skills has demonstrated protective effects with regard to Nonsuicidal Self-Injury (NSSI) engagement; however, cross-sectional evidence suggests that the presence of comorbid conditions, such as alcohol use disorders, may negate these benefits. Aims: The current study leverages ecological momentary assessment (EMA) to examine the between-person and within-person relationships between positive coping strategies and NSSI risk among individuals with problematic alcohol use. Method: Undergraduate students ( n = 56) completed a 21-day EMA protocol, in which they completed four surveys per day asking about their use of several positive coping strategies and NSSI risk. Results: Socializing was the only coping strategy to demonstrate a protective effect on NSSI risk. Alternatively, the coping strategies of finding perspective, positive thinking, and sitting with feelings until they pass all increased risk for NSSI. Limitations: The current study was underpowered to disentangle relationships with urges to engage in NSSI and NSSI behaviors. Conclusion: The results suggest that using coping skills that may present physical barriers to engaging in NSSI may be effective for reducing momentary NSSI risk.

Purpose: To elucidate the underlying motivations, experiential dimensions, and cognitive perceptions in adolescents with depression and non-suicidal self-injury (NSSI)., Method: A descriptive qualitative design was used. Participants were 18 Chinese adolescents with depression and NSSI. Conventional content analysis was used for data analysis., Results: Three primary themes and 11 subthemes were identified: Triggers of NSSI (personal, family, school, and social factors); Experiencing Emotional Complexity in NSSI Implementation (mitigating psychological distress, awakening a sense of existential life, generating secondary negative emotions, stimulating reflections on life and death); and Perceptions and Understandings of NSSI Are Diverse (NSSI as a form of seeking validation or approval, an addictive behavior, a means to attain a sense of control, and unacceptable behavior)., Conclusion: Although nursing staff should provide comprehensive treatment and psychological support, efforts should also be made to strengthen caregiving skills of family members, thereby promoting overall physical and mental health of adolescents. [ Journal of Psychosocial Nursing and Mental Health Services, 62 (11), 47-55.].

This study explored the effectiveness of a short-term mindfulness-based intervention (MBI) on psychological distress, mindfulness levels, emotion regulation, and impulsivity among college students with non-suicidal self-injury (NSSI). Participants completed four questionnaires, including the Five Facet Mindfulness Questionnaire, the Depression Anxiety Stress Scale, the Emotion Regulation Questionnaire, and the Brief Barratt Impulsivity Scale, and two behavioral tasks, including an emotion regulation task and a stop signal task (SST), at three time points. Compared with the healthy group, the NSSI group had a significantly greater level of psychological distress and a lower level of mindfulness. Compared with the NSSI control group and the healthy group, the NSSI MBI group had significantly increased mindfulness levels and decreased psychological distress after the intervention. In the NSSI MBI group, regardless of which emotion regulation strategy was adopted when viewing negative pictures, the intensity of negative emotions during the emotion regulation task was significantly reduced. Moreover, in the NSSI MBI group, the effectiveness of the MBI on the mindfulness level, stress level, and emotion regulation process was maintained at the follow-up. The present study provided empirical support that short-term MBI has the potential to help individuals with NSSI by enhancing their emotion regulation., (© 2024 International Association of Applied Psychology.)

Previous epidemiological studies have reported a short-term association between ambient temperature and suicide risk. To gain a clearer understanding of this association, it is essential to differentiate the risk factors for intentional self-harm (ISH) from those specifically associated with suicide deaths. Therefore, this study aims to examine whether the association between daily temperature and ISH or suicide deaths differs by age and sex. Between 2014 and 2019, cases of emergency room visits related to ISH and suicide deaths in Seoul were identified. A time-stratified case-crossover design was used to adjust for temporal trends and seasonal variation. A distributed lag nonlinear model was used to analyze the nonlinear and time-delayed effect of ambient temperature on ISH and suicide deaths. Positive associations were observed between temperature and both ISH and suicide deaths. For ISH, the relative risk (RR) was high at 1.17 (95% confidence interval (CI): 1.03, 1.34) for a temperature of 25.7 °C compared with 14.8 °C. The RR for suicide death was higher than those for ISH, at 1.43 (95% CI: 1.03, 2.00) for a temperature of 33.7 °C. These associations varied by age and sex, with males and females aged 35-64 years showing increased susceptibility to suicide deaths. This study provides detailed evidence that unusually high temperatures, both anomalous and out of season, may trigger suicidal behaviors, including both ISH and suicide deaths., (© 2024. The Author(s).)

SATB2-associated syndrome (SAS) is a genetic syndrome characterised by intellectual disability, severe speech delay, and palatal and dental problems. Behaviours that challenge (BtC) are reported frequently; however, there is limited research on specific forms of BtC and the correlates of these behaviours. The current study explores correlates of well-defined BtC, self-injury, aggression, and property destruction, in SAS. Eighty-one parents/caregivers of individuals with SAS (53.1% male, Mage 10.12 years) completed questionnaire measures of health, behavioural, emotional, and autism characteristics. Individuals with SAS were grouped based on caregiver responses to the presence or absence of self-injury, aggression, and property destruction on the Challenging Behaviour Questionnaire. Rates of self-injury, aggression and property destruction were 42%, 77% and 49%, respectively. Between-group comparisons were conducted to compare characteristics between behaviour groups. Significantly differing characteristics were entered into separate hierarchical logistic regressions for each form of BtC. Behavioural comparisons indicated variation in the characteristics associated with each behaviour. All hierarchical logistic regression models were significant (p < .001): self-injury (χ 2 (5) = 38.46, R 2  = 0.571), aggression (χ 2 (4) = 25.12, R 2  = 0.414), property destruction (χ 2 (4) = 23.70, R 2  = 0.346), explaining between 34.6% and 57.1% of the variance in behaviour presence. This is the first study to identify correlates of self-injury, aggression, and property destruction in SAS. Variability in the characteristics associated with each behaviour highlights the importance of specificity when examining BtC. Understanding correlates of specific forms of BtC has important implications for informing SAS-associated pathways to behavioural outcomes and the implementation of tailored behavioural interventions., (© 2023. The Author(s).)

Sexual minority adolescents (SMA) have a disproportionately high prevalence of victimisation, self-harm, and depressed mood, relative to the general population. Yet, the contributing and mechanistic factors are unclear. We aim to explore the directional relationship between victimisation and self-harm and depressed mood, with poor sleep quality as a possible mediator. A secondary data analysis was conducted using a nationally representative birth cohort in the United Kingdom, where participants self-identified as sexual minority (N = 1922, aged 11-13, 67.1% female) and their parents completed questionnaires and interviews when the participants were aged 11, 14 and 17. Logistic and linear regression were used to test whether victimisation prospectively predicted self-harm and depressed mood with mediation analyses conducted to assess if sleep onset latency and nocturnal awakening mediated their relationships. After adjusting for demographic factors and baseline self-harm and depressed mood, victimisation at age 11 significantly predicted self-harm (OR = 1.40, p < .01) and depressed mood (B = 0.024, SE = 0.01, p < .05) at age 17. In the mediation analyses, frequent nocturnal awakening at age 14, but not sleep onset latency, significantly mediated the effect of victimisation at age 11 on self-harm (indirect effect B = 0.008, SE = 0.004, 95%CI = 0.001-0.017) and depressed mood (indirect effect B = 0.005, SE = 0.002 95%CI = 0.001-0.010) at age 17. Our findings supported that victimisation contributed to negative mental health among SMA. Poor sleep quality could be an indicator of maladjustment with victimisation, which further increased vulnerability to negative mental health. Victimisation and sleep quality could be important assessment targets in mental health campaign among sexual minority adolescents., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: Nonsuicidal self-injury (NSSI) is rare in childhood but becomes prevalent in adolescence, which suggests that early intervention might be indicated. As childhood predictors of NSSI in adolescence are largely unknown, identifying these predictors was the aim of this study., Method: In a birth cohort sample (n = 759) of Norwegian children, NSSI at 12, 14, or 16 years of age was regressed on predictors of NSSI at age 6 (parental factors: depression, parenting stress, negativity/hostility, emotional availability to the child; child factors: temperamental negative affectivity, emotion regulation, symptoms of emotional and behavioral disorders; external events: victimization from bullying, serious negative life events). Semistructured clinical interviews with adolescents and their parents were used to assess DSM-5-defined NSSI and NSSI disorder., Results: NSSI during the preceding 12 months at 12, 14, or 16 years of age was reported by 81 adolescents (10.0%, 95% CI 8.2-11.9), and NSSI disorder was reported by 20 adolescents (2.7%, 95% CI 1.9-3.8). In multivariable logistic regression analysis, female gender (odds ratio 11.6, 95% CI 4.0-33.5), parenting stress (odds ratio 4.8, 95% CI 1.4-16.5), and parental negativity/hostility (odds ratio 1.8, 95% CI 1.2-2.7) predicted NSSI, whereas child factors and external events were not predictive., Conclusion: Parental factors when the child is 6 years of age-parenting stress and negativity/hostility toward the child-predict NSSI in adolescence. Universal and indicated programs targeting these aspects of parenting during childhood might reduce NSSI in adolescence., Plain Language Summary: Almost 1 in 4 adolescents engage in deliberate self-harm without wanting to die from it. However, childhood predictors of nonsuicidal self-injury are largely unknown. This study from Norway followed 759 children from birth until adolescence. The authors found that children who perceived their parents as more negative and hostile at 6 years old were at increased risk of engaging in self-injury when they became adolescents. Children whose parents reported more stress in the parenting role were also at increased risk of engaging in self-harm during adolescence. The authors conclude alleviating parental stress and improving parent-child relations at an early age might decrease the risk of adolescent self-harm., Diversity & Inclusion Statement: We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work., (Copyright © 2024 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: Nonsuicidal self-injury (NSSI) is common in adolescence. Rumination is a key risk factor and often co-occurs with depressive symptoms. This is the first study to examine the joint longitudinal trajectories of rumination and depressive symptoms as predictors of NSSI, and the adverse experiences associated with these trajectories., Method: A community sample of 1,835 adolescents (55.9% male participants, 12.3 ± 0.5 years of age) completed questionnaires to assess adverse childhood experiences, rumination, depressive symptoms, and NSSI. Assessments were made 4 times over 18 months., Results: A parallel process growth mixture model showed that youth with high trajectories of rumination but low trajectories of depression had moderately increased odds of NSSI (2.43-fold, 95% CI 1.53-3.91) compared with adolescents with low trajectories of both rumination and depression. Odds ratios (ORs) in adolescents with low trajectories of rumination but increasing or high trajectories of depression were similarly elevated, suggesting that high trajectories of rumination or depression were risk factors in isolation. However, odds were 10.06-fold greater (95% CI 5.68-18.02) when high trajectories of rumination occurred in tandem with high trajectories of depression. Multinomial logistic regression showed that male sex (OR 10.54, 95% CI 5.66-19.63), peer victimization (OR 2.25, 95% CI 1.72-2.96), and parental alienation (OR 1.94, 95% CI 1.46-2.57) were key determinants of membership in the highest risk group., Conclusion: Risk for NSSI is markedly increased in adolescents with high longitudinal trajectories of depression and rumination. Reducing exposure to peer victimization, cyber victimization, emotional abuse, parental alienation, and interparental conflict may reduce risk., Plain Language Summary: The authors of this study conducted a longitudinal analysis of 1,835 adolescents in the Peoples Republic of China to evaluate rumination and depressive symptoms as predictors of nonsuicidal self-injury. The authors found that high trajectories of either rumination or depression alone was associated with an elevated risk of nonsuicidal self-injury. The combination of high trajectories of both rumination and depression resulted in the highest risk. Male sex, peer victimization, cyber victimization, and parental alienation were more common in the highest trajectory risk groups., (Copyright © 2024 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Self-injurious thoughts and behaviours (SITBs) are a leading cause of death, and interpersonal processes (IPs) appear to play a role in SITBs. This systematic review synthesises the literature on IPs and SITBs in daily life and addresses four critical questions: (1) Which IPs have been assessed and how, (2) How are differences in IPs between individuals associated with SITBs?, (3) How are differences in IPs within individuals associated with SITBs? and (4) Do IPs relate differently to self-injurious thoughts than behaviours? Our review followed PRISMA guidelines and eligible literature was screened until 25 April 2024. We identified 58 Experience Sampling studies (32.76% daily-diary studies) of which most focused on IPs from major SITBs theories (e.g., thwarted belongingness) but largely used inconsistent operationalizations. Results from 39 studies investigating within-person associations were mixed. Based on 26 studies, whether differences in IPs between individuals relate to SITBs remains unclear. Three studies have investigated whether IPs relate to the transition from thoughts to behaviours, but temporal models are needed to draw firm conclusions. Studies investigating IPs and SITBs in daily life are largely inconclusive. Psychometrically validated measures are warranted, and future daily-life studies would benefit from drawing on ideation-to-action frameworks., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Aims: We aimed to investigate the relationship between Cognitive Disengagement Syndrome (CDS) and non-suicidal self injury (NSSI) in adolescents with attention deficit hyperactivity disorder (ADHD)., Methods: A semi-structured psychiatric interview and an NSSI screening questionnaire were conducted. Questionnaires assessing CDS (with daydreamer, sleepy, and slow subdimensions), depression, anxiety, self-esteem, emotion regulation, coping strategies, and loneliness were administered., Results: Among 104 participants (n: 63, 60.6% girls), the combined type of ADHD was the most common (66.3%), and 35 adolescents (27 girls) were in the NSSI+ group. Although only depression and ADHD were found to be predictors of NSSI in ADHD, CDS was associated with many risk factors of NSSI in ADHD: depression, anxiety, emotion dysregulation, low self-esteem, and emotion-oriented coping ways. After controlling for the effects of cognitive problems/inattentiveness, depression, and anxiety, CDS still correlated with low self-esteem and emotion dysregulation. The daydreamer and slow sub-dimensions of CSD differed between NSSI+ and NSSI- groups, while sleepy did not., Conclusions: CDS is associated with several relevant factors, indirectly relating it to self-harm in ADHD. CDS increases the vulnerability to mental health changes that could lead to NSSI in adolescence with ADHD., (© 2024 John Wiley & Sons Australia, Ltd.)

Aim: To evaluate the implementation of a mixed virtual and in-person brief intervention for young people, aged 12-25 years, presenting to a large urban mental health service in crisis with suicidal ideation and/or self-harm., Methods: A pragmatic, real-world evaluation was conducted on the Youth Brief Intervention Service between June 2021 (inception) and October 2022. Service users were offered four sessions over an approximate one-month period. Sessions focused on distress tolerance, safety plans and support systems. Implementation outcomes related to service uptake, retention, fidelity of the model and service user experience. Effectiveness outcomes were measured pre-post and included mental health-related hospital service utilization (primary outcome), functioning, mental health status, self-harm, suicidal ideation and quality of life., Results: Of the 136 young people referred to the Youth Brief Intervention Service, 99 were accepted with 17 disengaging before the first session. Eighty percent of people who commenced, completed the package of care. Young persons' and parent/carers experience of service was high (97% and 88%, respectively). Mental health-related emergency department presentations and inpatient days decreased from 3 months pre-intake to 3 months post-intake (42 vs. 7 presentations, X 2  = 25.3, p < .001; 11 vs. 0 inpatient days, X 2  = 9.1, p = .01). There were significant improvements in mental health status, days engaging in self-harm, general health and functioning and quality of life., Conclusions: The Youth Brief Intervention Service is feasible, acceptable, subjectively beneficial and coincided with less mental health-related emergency department presentations and inpatient days, and improved mental health status and behaviour., (© 2024 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Background: Self-harm in children and young people is increasing. Parents are vital in supporting young people; however, parents may experience distress linked to the self-harm. Previous reviews have highlighted the emotional impact and need for information and support, however, have not elucidated the relationships between these themes, nor examined the quantitative data examining parents' well-being., Methods: We conducted a mixed methods review, with qualitative meta-synthesis focusing on links between themes and quantitative synthesis of parental well-being findings, including pooled means. PsycInfo, Medline, EMBASE, AMED, CINHAL and Web of Science were searched to identify relevant records. References of included studies were also searched. Every abstract was screened by two authors. Data were extracted by one author and checked by another., Results: We identified 39 reports of 32 studies: 16 with qualitative data and 17 with quantitative data (one had both). Qualitative findings showed how parents' emotions were associated to their knowledge and beliefs about self-harm. Parents' emotions often evidenced the need to self-care, but emotions of guilt reduced engagement in self-care. How parents supported their young person was linked to their knowledge, and the management of their own emotions, and influenced if they could engage in self-care. Quantitative findings were mixed, however suggested poor general mental health amongst these parents., Conclusions: Further good quality quantitative studies are needed, with measurement of psychological mechanisms that may underpin parental distress. Current evidence supports peer-support and interventions that go beyond information provision to address the connected factors of knowledge, emotion, self-care, and parenting behaviours., (© 2024 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Background: Childhood emotional maltreatment, non-suicidal self-injury and depression are prevalent among adolescents with mood disorders. While existing model indicated that childhood emotional maltreatment, functions of non-suicidal self-injury and depression are interrelated, not much is understood about the interplay of functions of non-suicidal self-injury in the relationship between childhood emotional maltreatment and depression. Thus, the goal of this research was to ascertain how functions of non-suicidal self-injury relate to childhood emotional maltreatment and depression., Methods: The participants were adolescents with mood disorders from three hospitals in Sichuan Province, data was collected using self-administered questionnaires, including the Childhood Trauma Questionnaire, Ottawa Self-injury Inventory-Functions, and Childhood Depression Inventory. SPSS26.0 software and PROCESS v3.3 model 4 were used for analysis., Results: In all, 235 adolescents (M age =14.8, SD = 1.62) participated in the research. The functions of non-suicidal self-injury (r = 0.289, P < 0.01) and depression (r = 0.475, P < 0.01) were considerably positively connected with childhood emotional maltreatment, and the functions of non-suicidal self-injury were strongly positively correlated with depression (r = 0.364, P < 0.01). The direct impact of childhood emotional maltreatment on depression in adolescents was found to be significant (95% CI 0.434, 0.828) in the mediated effects model. Additionally, the indirect effect of childhood emotional maltreatment on depression through functions of non-suicidal self-injury was found to be significant (95% CI 0.055, 0.236), with a mediating effect value of 17.58%., Conclusion: Childhood emotional maltreatment has a direct impact on depression, but it also has an indirect influence through mediation roles of functions of non-suicidal self-injury. Medical staff should take care of the mental health of adolescents hospitalized for mood disorders so that they can clarify the role of functions of NSSI in lowering depressive symptoms and improving quality of life and create more targeted and effective intervention plans., (© 2024. The Author(s).)

Risky decision-making putatively contributes to nonsuicidal self-injury (NSSI) yet empirical support for this association is inconsistent. Studies have not simulated socioemotional contexts most closely linked to NSSI, which may partially explain mixed findings. Accordingly, we examined the association between NSSI and risky decision-making following the receipt of criticism from a close other, a key interpersonal context. The study included 286 university students (Mage = 21.11) oversampled for a lifetime history of NSSI. Participants completed a modified Iowa Gambling Task, in which they chose to play or pass on "good" and "bad" decks associated with monetary gains and losses. Participants also completed the Criticism Gambling Task, which was identical to the Iowa Gambling Task except critical audio comments preceded each block of trials. Based on results of multilevel growth curve analyses, decreases in risky decision-making were steeper on the Iowa Gambling Task compared to the Criticism Gambling Task, suggesting poorer learning in the context of criticism. Further, how past-month NSSI was related to changes in risky decision-making across blocks differed between the two tasks, b = -0.004, t(3140.00) = 2.48, p = .013. On the Iowa Gambling Task, all participants decreased their risky decision-making, whereas on the Criticism Gambling Task, higher past-month NSSI frequencies were associated with riskier decision-making. Our findings support associations between risky decision-making and NSSI in negative socioemotional contexts, consistent with functional models of NSSI., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nancekivell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Previous studies have suggested a significant association between mobile phone addiction (MPA) and non-suicidal self-injury (NSSI) in general adolescents. However, limited research has analyzed this relationship in clinical populations, such as those with major depressive disorder (MDD), and the potential mediation mechanisms remain unclear., Methods: This cross-sectional observational study analyzed data from 2343 adolescents with MDD (77.9% females; mean age = 14.99 years, SD = 1.65). Using mediation models, we explored the roles of self-esteem and depression severity (measured by Patient Health Questionnaire-9) in the relationship between MPA and NSSI. Additionally, we evaluated the associations between existing school-implemented mobile phone usage policies and levels of MPA, self-esteem, depression symptoms, and NSSI., Results: MPA was significantly associated with NSSI, with low self-esteem and increased depression severity almost entirely mediating this effect (log-odds = 0.016, 95%CI = 0.02-0.013). Subdomains of MPA, including inability to control craving, feelings of anxiety, and productivity loss, followed similar mediation models, while the subdomain of withdrawal/escape had a partial effect mediated by depression severity. Additionally, enforced restrictions on mobile phone usage in schools did not show positive effects on related variables and even exacerbated MPA by increasing cravings and reducing productivity., Conclusion: Our study suggests that MPA in adolescents with MDD may be an important risk factor for NSSI occurrence, and that reducing the negative impact of mobile phone usage on self-esteem and depressive symptoms, rather than simply restricting usage, may be crucial for effective intervention., (© 2024. The Author(s).)

Background: Non-suicidal self-injury (NSSI) behaviors pose a significant threat to the physical and psychological well-being of adolescents. Recent research suggests that persistent, uncontrollable and repetitive NSSI can be conceptualized as a behavioral addiction. The addictive feature of NSSI behavior can be assessed using Ottawa self-injury inventory (OSI), the higher addiction score indicates the more serious NSSI behavior. This study aims to explore the relationship of impulsivity and decision-making on the addictive features of NSSI in adolescents with depressive disorder, to explore the influencing factors of behavioral addictive features of NSSI and to predict the addictive features of NSSI., Methods: Using a cross-sectional design, a total of 126 adolescent outpatients and inpatients with a mean age of 15.49 years old (M = 15.49, SD = 1.56), male students (n = 28, 22.2%) and female students (n = 98, 77.8%) diagnosed with depressive disorders were recruited according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and clinical interviews were completed by two psychiatrists. NSSI addictive features according to the OSI's addictive features items. The final group was categorized into three groups: depression without NSSI (n = 42), depression with NSSI without addictive features (n = 44), and depression with NSSI and addictive features (n = 40). The present study employed the Hamilton Depression Scale (HAMD-24), Chinese Revised Barratt Impulsiveness Scale Version 11 (BIS-11), OSI, and the Adolescent Non-Suicidal Self-Injury Questionnaire (ANSSIQ). Cognitive decision-making abilities were assessed using the Iowa Gambling Task (IGT)., Results: The depression with NSSI addictive features group had significantly lower total net scores and net scores of block3, block4, and block5 in the IGT than the depression without NSSI group, whereas there was no statistically significant difference between the two in net scores of block1 and block2. Lower scores mean more unfavorable decisions and strategy adjustments. The addictive features of NSSI behaviors were significantly and positively correlated with the severity of NSSI behaviors, depression, and cognitive impulsiveness, and significantly and negatively correlated with the total net score of the IGT. The severity of NSSI behaviors, severity of depression, cognitive impulsiveness positively predicts the addictive features of NSSI behaviors, the total net score of the IGT negatively predicted the addictive features of NSSI behaviors., Conclusion: Adolescents with depressive disorders with NSSI behavioral addictive features had higher severity of depression, exhibited higher cognitive impulsivity, and made more unfavorable decisions when making choices., (© 2024. The Author(s).)

Background: Recent evidence indicates that the risk of death by suicide in teenagers has increased significantly worldwide. Consequently, different therapeutic interventions have been proposed for suicidal behavior in this particular population. Therefore, the main objective of this study is to provide an updated review of the existing psychological interventions for the treatment of suicide attempts (SA) in adolescents and to analyze the efficacy of such interventions., Methods: A systematic review was conducted following PRISMA guidelines. The studies were identified by searching PubMed, PsychINFO, Web of Science, and Scopus databases from 2016 to 2022. According to the inclusion criteria, a total of 40 studies that tested the efficacy of different psychological interventions were selected., Results: Various psychological interventions for adolescents with suicidal behaviors were identified. Most of those present promising results. However, to summarize results from recent years, dialectical behavior therapy (DBT) was the most common and the only treatment shown to be effective for adolescents at high risk of suicide and SA. In contrast, empirical evidence for other psychological interventions focusing on deliberate self-harm (SH) is inconclusive., Conclusions: Interventions specifically designed to reduce suicidal risk in adolescents have multiplied significantly in recent years. There are a few promising interventions for reducing suicidal behaviors in adolescents evaluated by independent research groups. However, replication and dismantling studies are needed to identify the effects of these interventions and their specific components. An important future challenge is to develop brief and effective interventions to reduce the risk of death by suicide among the adolescent population., (© 2024. The Author(s).)

Background: A self-harm episode is a major risk factor for repeat self-harm. Existing tools to assess and predict repeat self-harm have major methodological limitations, and few are externally validated., Objective: To develop and validate a risk assessment model of repeat self-harm up to 6 months after an episode of non-fatal self-harm that resulted in an emergency visit to hospital or specialised care., Methods: Using Swedish national registers, we identified 53 172 people aged≥10 years who self-harmed during 2008-2012. We allocated 37 523 individuals to development (2820 or 7.5% repeat self-harm incidents within 6 months) and 15 649 to geographic validation (1373 repeat episodes) samples, based on region of residence. In a temporal validation of people who self-harmed during 2018-2019, we identified 25 036 individuals (2886 repeat episodes). We fitted a multivariable accelerated failure time model to predict risk of repeat self-harm., Findings: In the external validations (n=40 685), rates of repeat self-harm were 8.8%-11.5% over 6 months. The final model retained 17 factors. Calibration and discrimination were similar in both validation samples, with observed-to-expected ratio=1.15 (95% CI=1.09 to 1.21) and c-statistic=0.72 (95% CI=0.70 to 0.73) in the geographical validation. At 6 months and a 10% risk cut-off, sensitivity was 51.5% (95% CI=48.8% to 54.2%) and specificity was 80.7% (95% CI=80.1% to 81.4%) in geographic validation; corresponding values were 56.9% (95% CI=55.1% to 58.7%) and 76.0% (95% CI=75.5% to 76.6%) in temporal validation. Discrimination was slightly worse at the 1-month prediction horizon (c-statistics of 0.66-0.68)., Conclusions: Using mostly routinely collected data, simple risk assessment models and tools can provide acceptable levels of accuracy for repeat of self-harm., Clinical Implications: This risk model (OXford SElf-harm repeat tool) may assist clinical decision-making., Competing Interests: Competing interests: HL reports receiving grants from Shire Pharmaceuticals; personal fees from and serving as a speaker for Medice, Shire/Takeda Pharmaceuticals and Evolan Pharma AB; all outside the submitted work. HL is editor-in-chief of JCPP Advances., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Searches for "pro-suicide" websites in the United States peaked during the week a high-profile news story was published and remained elevated for 6 months afterward, highlighting the need to avoid mentioning specific sources of explicit suicide instructions in media publications., (©Nora Clancy Kelsall, Catherine Gimbrone, Mark Olfson, Madelyn Gould, Jeffrey Shaman, Katherine Keyes. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 15.10.2024.)

Background: Childhood Emotional Abuse (CEA) is a known risk factor for Non Suicidal Self-injury (NSSI), which could have devastating repercussions. This study aimed to establish whether Parent-Child Attachment (PCA) and depressive symptoms mediated the CEA-NSSI relationship, as well as whether school connectedness moderated both the direct and indirect relationships between CEA and NSSI., Methods: Between November and December 2022, 7447 Chinese adolescents in high schools were surveyed through multi-stage cluster random sampling. The participants completed self-reported questionnaires that assessed CEA, PCA, depressive symptoms, school connectedness, and NSSI. Relationships between these variables were examined through moderated mediation analysis using SPSS macro-PROCESS., Results: After controlling for sociodemographic variables, we found that CEA correlated positively with NSSI through two different pathways: the mediating role of depressive symptoms and the chain-mediating role of both PCA and depressive symptoms. Moreover, school connectedness could moderate the direct and indirect relationships between CEA and NSSI., Limitations: The study's cross-sectional design does not allow for causal inferences., Conclusions: Overall, PCA, depressive symptoms, and school connectedness could affect the CEA-NSSI relationship., Competing Interests: Declaration of competing interest The authors(Qiaoyue wei, Jianbo Liu, Wenwen Yin, Shuibo Pan, Chenyangzi Dai, Linhua Zhou, Xiaoyu Jiang, Chunyan Wang and Junduan Wu) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Suicidal thoughts and behaviors often emerge in a predictable sequence, with suicidal ideation (SI) preceding planning, and planning preceding actions. Few studies, however, have considered the timing and duration of non-suicidal self-injury (NSSI) in these transitions. Accordingly, this study examined: 1) the developmental sequencing of NSSI, SI and suicide attempts, and 2) whether age of onset or duration predict transitions from NSSI to other SITB, and from SI to NSSI., Methods: 704 first-year students from a mid-sized Canadian university (Sample 1) and 2095 adults from an online research volunteer panel (Sample 2) completed the Self-Injurious Thoughts and Behaviors Interview self-report, which assessed the presence, age of onset, and recency of SITB., Results: NSSI and SI typically onset before age 15, while suicide planning and attempt usually began at or after age 15. Transition from NSSI to SI was likeliest in the first year after NSSI onset. Transition from NSSI to suicide attempt was likeliest in the second and third year after NSSI onset in Sample 1, and up to four years after NSSI onset in Sample 2. Early (before age 13) and late (after age 16) onsets of NSSI predicted higher odds of transitioning from NSSI to SI or attempt. Transition from SI to NSSI was likeliest in the first two years after SI onset and when SI began before age 13., Conclusions: The first year after NSSI or SI onset are critical for transitions to other SITB. Targeted prevention and monitoring should be considered for people who recently initiated NSSI., Competing Interests: Declaration of competing interest The authors declare none., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Competing Interests: We declare no competing interests.

Competing Interests: Declaration of interests PM reports grants from National Institute for Health and Care Research (NIHR), the Medical Research Council (MRC), Bristol & Weston Hospitals Charity, and The Cassell Hospital Charitable Trust; and salary support from the NIHR Applied Research Collaboration Southwest, the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation, and Avon and Wiltshire Mental Health Partnership NHS Trust. NK reports grants from NIHR, Health Quality Improvement Partnership, and the Department of Health and Social Care; has received salary support from the Greater Manchester NIHR Patient Safety Research Collaboration, Mersey Care NHS Foundation Trust, and the University of Manchester; has chaired and contributed to committees for the National Institute for Health and Clinical Excellence (NICE) guidelines, including those on the management of self-harm; and is a member of the National Suicide Prevention Strategy Advisory Group (England). RCO is a trustee and science council member of MQ Mental Health Research, president of the International Association for Suicide Prevention, co-chair of the academic advisory group to the Scottish Government's National Suicide Prevention Leadership Group, and a board member of the International Academy of Suicide Research; was a member of the NICE guideline group for the management of self-harm; and reports grants from Medical Research Foundation, the Mindstep Foundation, Chief Scientist Office, MRC, Public Health Scotland, Scottish Government, NIHR, Shout 85258, Scottish Association for Mental Health, Zoetis Foundation, Jonathan's Voice, ADHD UK, and Barfil Charitable Trust. HC reports grants from the National Health and Medical Research Council (NHMRC), the Medical Research Future Fund, Paul Ramsay Foundation, and the Australian Government; is Scientia Professor at the University of New South Wales, supported by an NHMRC Elizabeth Blackburn Research Fellowship, and chief investigator on the NHMRC Centre for Research Excellence in Suicide Prevention; sits on the Million Minds Committee; and is a director of the Black Dog Institute Board and the Ramsay Health Care Research Foundation. MS declares salary support through academic scholar awards from Sunnybrook Health Sciences Centre and the University of Toronto. OJK is currently supported by a Research Foundation Flanders Senior Postdoctoral Fellowship; reports grants from Research Foundation Flanders and the King Baudouin Foundation; is co-chair of the International Association for Suicide Prevention Early Career Group, for which she receives complimentary student membership; is a former member of the Samaritans research ethics board; and has previously received travel grants and waived registration to present at conferences of the International Academy of Suicide Research. JP reports grants from NHMRC, the Medical Research Future Fund, Department of Health of the Australian Government, New South Wales Health, and the National Suicide Prevention Office. LFC is the vice president of the International Association for Suicide Prevention and is a permanent member of the Malaysian technical working group for suicide prevention; reports grants from the Centre of Pesticide Suicide Prevention at the University of Edinburgh; has received honorarium from Johnson & Johnson as a consultant and speaker; and, through her institution, has received access to the industry-sponsored medication sampling programme (compassionate patient programme) for clinical use for medication samples of esketamine (Johnson & Johnson), brexpiprazole (Lundbeck), Abilify Maintena (Lundbeck), and Trinza (Johnson & Johnson). DK is funded through the Elizabeth Blackwell Institute for Health Research at the University of Bristol, which is supported by the Wellcome Trust; has received grants from the Centre for Pesticide Suicide Prevention and the American Foundation for Suicide Prevention; and is a steering group member of the UK's National Suicide Prevention Alliance, and the Migration Health and Development Research Initiative. VP has consulted with Google and Modern Health (unrelated to the scope of this project). AC reports grants from Wellcome Trust, Leverhulme Trust, Economic and Social Research Council; has received funded consultancy from the Scottish Government and Alcohol Change UK; and is a member of the academic advisory group to the Scottish Government's National Suicide Prevention Leadership Group. SPe reports a 2021–2024 Vanier Canada Graduate Scholarship from the Canadian Institutes of Health Research. NS is a lived experience advisor to the Wellcome Trust, consumer academic at the University of Melbourne, lived experience lead at the Royal Children's Hospital, member of the Lived Experience Air Academy for University of Wollongong's Project Air, lived experience director for the Australian BPD Foundation, and associate at yLab (a division of the Foundation for Young Australians); reports previous employment with Orygen, and previous roles with the Youth Affairs Council of Victoria, Victorian Department of Families, Fairness, and Housing, Victorian Department of Premier and Cabinet, and Moonee Valley City Council; funded travel through Black Dog Institute and International Association of Suicide Prevention; and a current research tie to Orygen. FSt reports a grant from the Burdett Trust for Nursing and support from Abertay University. PSFY is a member of the advisory committee on mental health for the government of the Hong Kong Special Administrative Region. All other authors declare no competing interests.

Background: Comorbidity between non-suicidal self-injury (NSSI) and depression and anxiety was common. In the framework of network theory, the examination of directionality and gender differences in longitudinal relationships at the symptom level made a significant contribution to the understanding of comorbidity. Therefore, this study employed cross-lagged panel network analysis to investigate the longitudinal interrelations between NSSI and depression and anxiety in Chinese adolescents, with a focus on gender differences., Method: The study was conducted with a sample of 884 senior high school students (F/M: 481/403; mean age: 15.19 ± 0.48 years) from Jinchang City, Gansu Province, China. All respondents completed the Adolescent Non-Suicidal Self-Injury Assessment Questionnaire and the two subscales (depression and anxiety) of the Brief Symptom Inventory at two intervals. The data were estimated in R 4.2.0 to construct the cross-lagged panel network (CLPN)., Results: The CLPN results uncovered the gender differences. For boys, self-hitting and feeling scared emerged as central symptoms. Cutting predicted subsequent feelings of sadness ( β  =  - 0.57), tension ( β  =  - 0.52) and indifference ( β  =  - 0.49), potentially serving as a bridge connecting NSSI to depression and anxiety. For girls, biting themselves and feeling scared were central symptoms. Carving and skin rubbing predicted subsequent feelings of indifference ( β  =  - 0.31, -0.21), bridging NSSI to depression and anxiety. In addition, feeling scared emerged as the key bridge symptom connecting depression and anxiety., Conclusion: The findings showed the gender-specific developmental characteristics of the directional relations between NSSI and depression and anxiety at the symptom level. They provided new insights into the comorbidity of NSSI and depression and anxiety, carrying important implications for the screening and intervention of adolescent NSSI., Competing Interests: The authors declare there are no competing interests., (©2024 Zhao and Zhou.)

Importance: A major portion of adolescents and adults seeking psychiatric treatment report nonsuicidal self-injury (NSSI) within the past month, yet the short-term course of NSSI among these patients remains poorly understood., Objective: To advance the understanding of the short-term course of NSSI cognitions (ie, thoughts, urges, and self-efficacy to resist self-injury) and behavior., Design, Setting, and Participants: A cohort study was conducted using an intensive longitudinal design with ecological momentary assessment, including 6 daily surveys and event registrations of self-injury for 28 days. Data were collected from June 2021 to August 2023. Individuals using mental health services in the Flanders region in Belgium reporting past-month NSSI urges and/or behavior at intake were recruited by referral., Main Outcomes and Measures: Nonsuicidal self-injury thoughts, urges, self-efficacy, and behavior. Sociodemographic and clinical baseline characteristics served as between-person variables. Descriptive and variability statistics and dynamic structural equation modeling were used., Results: Participants completed a mean (SD) of 121 (34.5) surveys, totaling 15 098 longitudinal assessments (median adherence, 78.6%; IQR, 59.5%-88.7%). Among 125 patients (87.2% female; median age, 22.0 [range, 15-39] years; 52.8% heterosexual), NSSI thoughts and urges were present during most assessments but were low in intensity (individual means [SD] on a 0- to 6-point scale, 1.52 [1.13] for urges; 1.57 [1.18] for thoughts). The prevalence of NSSI behavior was 84.0% monthly, 49.90% weekly, and 18.19% daily. Between-patient variability was substantial (intraclass correlation coefficient, 0.43-0.47; range of individual means for cognitions, 0-6; individual frequency behavior, 0-103), with recency and frequency of NSSI thoughts and behavior at intake consistently associated with individual differences in the course of NSSI. The greatest variability was observed within patients (root mean square of successive differences from 1.31 for self-efficacy to 1.40 for instability of thoughts), characterized by changes in the intensity of cognitions by more than 1 within-person SD between assessments less than 2 hours apart in 1 of 5 instances. Nonsuicidal self-injury behavior is rare in the morning, increased in the afternoon, and most frequent in the evening. Nonsuicidal self-injury cognitions were contemporaneous and temporally associated with each other's course, with higher-than-usual thoughts and lower self-efficacy uniquely signaling heightened risk for NSSI behavior in the next 2 hours., Conclusions and Relevance: In this cohort study of treatment-seeking individuals, NSSI cognitions and behavior appeared to be dynamic over the short term. These findings suggest the potential utility of self-monitoring outside the therapy setting and the need to focus assessment and interventions on the evening hours.

No abstract present.